The Injured Child

Question 1

What is the epidemiology of paediatric trauma?

Answer 1

Commonest cause of death, boys 3x more than girls. Usually blunt trauma

Question 2

What are the age appropriate values and physiological responses of children to trauma?

Answer 2

X

Question 3

What are the differences in mechanism and pattern of injury?

Answer 3

Different anatomical features, different response to injury
Eg
- Smaller target (greater energy for same force of impact)
- Large surface area to volume ratio (lose heat quickly)
- Larger head
- Smaller mass (drug doses and fluid requirements differ)
- Skeleton is soft, springy and deforms rather than breaks (less protection for organs)
- less elastic connective tissue so prone to shearing and devolving
- thermoregulation is harder
- cold can lead to hypoglycaemia

Mechanism: take good history, “read the wreckage”, do injuries fit story

Question 4

What is the psychological impact of trauma on children?

Answer 4

May have communication difficulties (too young/afraid)

Fear affects vital signs, distressed parents, effects on staff

Longer term: may have an effect on growth and development

Question 5

What are the basic phases of paediatric resuscitation and it’s practical problems?

Answer 5

First peak
Second peak - ABCD problems
Third peak

Aim: restore normal tissue oxygenation as quickly as possible

• cABCDE
• primary survey + resuscitation
• secondary survey
• emergency treatment
• definitive care
• reassessment

Question 6

What are the common patterns of injury? including cuts, burns, head injuries and fractures

Answer 6

Fractures: buckle, clavicular, toddlers fracture, green stick, Growth plate injuries (salter Harris classification)

Wounds: understand depth, extent, mechanism of injury

Burns and scalds: more common in children than adults, usually superficial (remember inhalation and poisoning)

Head injury: very common eg from falls, trips, accidents

Drowning

Other common injury patterns: SCIWORA, lap belt syndrome

Question 7

What are the serious illnesses and injury? including drowning, neck/spinal cord trauma and chest/abdominal pain

Answer 7

Respiratory failure eg obstruction (foreign body, pneumothorax), depression (raised ICP via head injury)
Circulatory failure eg fluid loss (burns, trauma), fluid maldistribution (sepsis)

Question 8

What is injury prevention in children?

Answer 8

X